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Defining appropriate treatment and outcomes for spinal deformity patients
The AOSpine Knowledge Forum Deformity and AOSpine community, used a Delphi process to define consensus on optimal treatment and core outcomes sets for both adolescent and adult spinal deformity patients. The findings are published in the European Spine Journal and the Acta Orthopedica and offer the latest up-to-date knowledge.
"The studies provide the AOSpine community and the spine deformity patient with new information to guide an evidence-based approach to optimal care", study investigator Dr. Sigurd Berven says.
The Delphi process is a methodology designed to establish consensus whereby the current opinions of a panel of experts are put forward in an iterative and anonymous process. Knowledge Forum Deformity Chairperson Prof. Marinus de Kleuver finds it extremely useful: "There is so much information out there these days. Consensus papers offer an extra layer of empirical opinion-leader-"Consensus papers offer an extra layer of empirical opinion-leader-knowledge to literature reviews, which are, by definition, outdated."knowledge to literature reviews, which are, by definition, outdated."
De Kleuver reckons expert knowledge is years ahead of the newest papers published, because data acquisition is done years earlier. "The world keeps moving on! There is a huge gap between what is being published and what is at the forefront of innovation and new techniques." This gap can be bridged with consensus papers, literature reviews supplemented by a Delphi expert panel process. "Ultimately, you are also validating the large multi-center studies, where work takes years", de Kleuver adds.
AOSpine network is instrumental
With the involvement of approximately 50 members from the AOSpine community, representing close to 30 countries from around the world, we have learned that there is significant variability in the management of "This is unique to AO, that you can leverage the international network of so many experts, and produce a proper global representation."spinal deformity between centers around the world, even within centers, Berven says, and gives credit to the worldwide community of AOSpine physicians. "They are a valuable resource for developing an evidence-based approach to optimal care of deformity. This is unique to AO, that you can leverage the international network of so many experts, and produce a proper global representation."
The studies identified several areas of variability in care, and through the Delphi process and consensus opinion, the panel could determine specific management strategies that were appropriate or inappropriate. This information is useful in guiding an evidence-based approach to care across the continuum, from preoperative preparation to surgery, to intraoperative "Importantly, the studies allow people to speak a common language, making comparative and collaborative research possible."standardization of techniques, and to postoperative care. The results also reveal the needs for a global implementation and remaining gaps. "There are still several areas in which we do not have enough evidence to make consensus recommendations on what is most appropriate or optimal care", Berven concludes. "We need further research regarding strategies for preoperative optimization, intraoperative techniques, and postoperative care, to better define specific approaches that are optimal for the individual patient, and specific scenarios of care."
Importantly, the studies allow people to speak a common language, making comparative and collaborative research possible. "All these initiatives are aimed at creating a framework to communicate across different parties", de Kleuver explains. "There is a myriad of outcome studies and outcome instruments out there, and everybody uses different instruments to measure their quality of care. We help bring more rationale to the options that are available."
For the full articles, follow links below:
- Berven SH, Kamper SJ, Germscheid NM, Dahl B, Shaffrey CI, Lenke LG, Lewis SJ, Cheung KM, Alanay A, Ito M, Polly DW, Qiu Y, De Kleuver M, AOSpine Knowledge Forum Deformity. An international consensus on the appropriate evaluation and treatment for adults with spinal deformity. Eur Spine J, 2017.
- De Kleuver M, Faraj S, Holewijn R, Germscheid N, Adobor R, Andersen M, Tropp H, Dahl B, Keskinen H, Olai A, Polly D, Hooff MV, Haanstra T. Defining a core outcome set for adolescent and young adult patients with a spinal deformity. A collaborative effort for the Nordic Spine Surgery Registries. Acta Orthopaedica [Epub ahead of print] 15 Sep 2017.
- Faraj SSA, Van Hooff ML, Holewijn RM, Polly DW, Jr., Haanstra TM, De Kleuver M. Measuring outcomes in adult spinal deformity surgery: a systematic review to identify current strengths, weaknesses and gaps in patient-reported outcome measures. Eur Spine J 26(8): 2084-2093, 2017.
- De Kleuver M, Lewis SJ, Germscheid NM, Kamper SJ, Alanay A, Berven SH, Cheung KM, Ito M, Lenke LG, Polly DW, Qiu Y, Van Tulder M, Shaffrey C. Optimal surgical care for adolescent idiopathic scoliosis: an international consensus. Eur Spine J 23(12): 2603-2618, 2014.
The authors are grateful to the many AOSpine surgeons and collaborators who participated in these studies:
Adult Spinal Deformity (ASD) Consensus (see above Berven et al. ESJ 2017)
Richard Emery, Mater Hospital | Brian Hsu, North Shore Institute of Spinal Disorders | Dianming Jiang, The First Affiliated Hospital of Chongqing Medical University | Xie En, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine | Arvind Bhave, Deenanath Mangeshkar Hospital | Ajoy Prasad Shetty, Ganga Hospital | Suhail Afzal, Police Hospital | Saumyajit Basu, Park Clinic | Vishal Moudgil, Pims Medical College | Bhavuk Garg, All India Institute of Medical Sciences | Yoshiharu Kawaguchi, Toyama University | Tomoaki Toyone, Teikyo University Mizonokuchi Hospital | Takashi Kaito, Osaka University Graduate School of Medicine | Chung Chek Wong, Sarawaka General Hospital | John Chen, Singapore General Hospital | Josef Grohs, Medical University Vienna | Christoph Mehren, Schön Klinik München Harlaching | Dimos Bouramas, Athens Bioclinic | Massimo Balsano, Regional Spinal Department | Pedro Berjano, IRCCS Istituto Ortopedico Galeazzi | Andrea Piazzolla, AOU Consorziale Policlinico Di Bari | Cajetan Nwadinigwe, National Orthopaedic Hospital | Traian Ursu, Foisor Orthopedics Hospital | Salvador Fuster, Hospital clinic-university of Barcelona | Cumhur Oner, UMC Utrecht | Ufuk Aydinli, Medicabil Private Hospital | Alexandre Cristante, IOT HC FMUSP | Emiliano Vialle, Cajuru Hospital |
Mauricio Campos Daziano, Pontificia Universidad Catholica de Chile | Nestor Adolfo Taboada Taboada, Clinica Portoazul | Herman Michael Dittmar, Hospital Puerta de Hierro | Mohamed Maziad, Faculty of Medicine AIn Shams University | Hany Soliman, Al Azhar University | Sherif Elghamry, Teachers Hospital | Amer Aziz, Lahore Medical and Dental College | Venugopal Menon, Khoula Hospital, Mina al Fahal | Vincent Arlet, University of Pennsylvania | John France, West Virginia University | Isador Lieberman, Texas Back Institute | Munish Gupta, University of California at Davis | Jeffrey Carlson, Orthopaedic and Spine Center | Jens-Peter Witt, University of Colorado Hospital | Dean Chou, University of California San Francisco | Ronald Lehman, Washington University School of Medicine | Justin Smith, University of Virginia | Jonathan Sembrano, University of Minnesota; Minneapolis VA Health Care System
Adolescent Idiopathic Scoliosis (AIS) Consensus (see above De Kleuver et al. ESJ 2014)
Ufuk Aydinli, Medicabil Hospital, Bursa | Amer Aziz, Ghurki Trust Teaching Hospital, Lahore | Saumyajit Basu, Park Clinic, Kolkata | Ernesto Bersusky, Garrahan Pediatric Hospital, Buenos Aires | Benny Dahl, Rigshospitalet, University Hospital of Copenhagen | Evan Davies, University Hospital Southampton | Maximo-Alberto Diez Ulloa, Universitary Hospitalary Complex Santiago de Compostela | Ignacio Dockendorff, Clínica Alemana de Santiago | Mohammad El-Sharkawi, Assiut University Medical School | Andre Luis Fernandes Andujar, Hospital Infantil Joana de Gusmão, Florianopolis | Brian Freeman, The University of Adelaide | Bhavuk Garg, All India Institute of Medical Sciences, Delhi | Wilmer Godoy, Roosevelt Institute, Bogota | Poornanand Goru, University Hospital of Wales, Cardiff | Tiziana Greggi, Rizzoli Orthopaedic Institute, Bologna | Michael Grevitt, Center for Spinal Studies, Queens Medical Center, Nottingham | Yong Hai, Beijing Chaoyang Hospital, Capital Medical University of China | Carol-Claudius Hasler, University Children’s Hospital, Basel | Philip Horsting, Sint Maartenskliniek, Nijmegen | Kannan Kailash, Sri Ramachandra University | Khalil Kharrat, Hotel-Dieu Hospital | Claudio Lamartina, Istituto Ortopedico Galeazzi, Milan | Isador Lieberman, Texas Back Institute | Venugopal Menon, Khoula Hospital, Muscat, Sultanate of Oman | Roman Nowak, Orthopaedic Clinic of Silesian Medical University | Samuel Pantoja, Roberto de Rio Children's Hospital - Clinica Las Condes Private Hospital | Rolf Riise, Oslo University Hospital | Saeid Safaei, Milad Hospital / AZAD University | Dietrich Schlenzka, ORTON Orthopaedic Hospital, Helsinki | Alpaslan Senkoylu, Gazi University, Ankara | Masood Shafafy, Center for Spinal Studies, Queens Medical Center, Nottingham | Jianxiong Shen, Peking Union Medical College Hospital | John Smith, University of Utah | Shanmuganathan Rajasekaran, Ganga Medical Centre & Hospitals Ltd. | Daisuke Sakai, Tokai University School of Medicine | Paul Thorpe, Somerset Spinal Surgery Service, Taunton | Warat Tassanawipas, Phramongkuthklao Army Hospital, Bangkok | Traian Ursu, University Hospital Foisor, Bucharest | Seyed Hossein Vahid Tari, Tehran University of Medical Science | Emiliano Vialle, Cajuru Hospital, Curitiba | Chung Chek Wong, Sarawak General Hospital
Newsletter 14 | December 2017